design lab

Design is a layer in almost every effort to improve health, but it is the layer most often left unplanned, unfunded, and unstaffed.

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It occupies two positions. Sometimes design is in support of the work: the interface that determines whether a diagnostic is used correctly, the form that determines whether a patient's history is legible to the next clinician who reads it. Sometimes design is the work: a device that makes water safe to drink, housing built for the heat that is coming rather than the heat that came. Each position fails in its own way. In the first, design is recognized as design and treated as finish work—scheduled last, funded from remainder. In the second, design is doing the entire job and is often not called design at all, which means no one plans or finances it as such. Two kinds of invisibility, one result.

Design has claimed a role in repair before. In the decades after the Second World War, a generation of designers believed that the made world could be reorganized toward health, and toward a peace that held. That belief returned in the 2000s under the banner of social and humanitarian design, and then receded—in part because the criticism of it was correct. Interventions arrived from outside, unasked for, without maintenance, financing, or local authorship. Some were worse than nothing. What followed the criticism was not a better model. It was a withdrawal.

While the withdrawal may have been warranted, the vacancy was not.

We think the failure common to both periods was one of execution rather than intent. Design arrives late, arrives alone, and arrives unfinanced. The Lab is organized around those three conditions: When, Who, and How Much?

When
There is a persistent asymmetry between reactive and proactive work, and it takes the same shape in two places. Considerable design capability is mobilized after a disaster—temporary housing, emergency supply, field devices—and comparatively little is directed at the conditions that made the disaster costly. Considerable clinical capability is mobilized once disease is established, and comparatively little at the conditions that let it take root. In both cases the later intervention is urgent, visible, and attributable to someone. In both cases the earlier one is cheaper.

The difficulty is that proactive work produces a benefit that is not easily measured or claimed: the flood that was survivable, the diagnosis that was not missed, the handoff that did not fail. Nothing happens, and nothing can be pointed to. Reactive work has the opposite property—it is legible, datable, and creditable to whoever paid for it. Design sits on the losing side of this in both domains. It is called after the storm and after the diagnosis. We are interested in why the asymmetry holds, and in what it would take to make an averted failure visible enough to be commissioned.

Who
Health problems are rarely written in a form a designer can act on, and designers are rarely in the room where those problems are described. The gap is not one of willingness. It is a translation failure, and it runs in both directions—between design and medicine, and between design disciplines that seldom work together. An architect and a graphic designer, an industrial designer and a digital product designer, hold complementary methods and almost no shared practice.

Design here is defined by scale rather than discipline. It includes the design of objects and interfaces, the design of the systems that deliver them, and the design of the institutions that finance and sustain them. Organizations are designed artifacts too, and badly designed ones defeat well-designed products routinely.

How Much?
Design is priced as an expense against a fixed budget, which is why it is cut first. But what reads as a failure of foresight is frequently a failure of accounting: the money that would fund an earlier intervention is rarely the money that captures the savings, and the interval between the two is often longer than the relationship between a payer and a patient, or between an administration and a city.

We are also interested in the opposite of the expense arrangement—design that pays for itself out of savings it produces elsewhere in a project. Construction and delivery costs in health and housing have grown far beyond the cost of materials and labor. The gap is process, not substance. Recovering even part of it would fund the design of community and health infrastructure that today goes unbuilt.

The following are early-stage Programs-of-Interest at the Design Lab:
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The Continuity Problem
A person's health record is a designed object that no one has designed. It is assembled from fragments held by parties with no obligation, incentive, or format for passing them along, and the cost of that fragmentation is borne almost entirely by the patient. The program treats continuity of care as an information design problem with an economic structure underneath it — asking what the record would look like if it were built for the person rather than the institution, and what would have to be true for anyone to build it.

The Geography of Disease
An atlas of where disease burden and health capacity fail to coincide—mapping not only incidence but the distribution of trials, specialists, facilities, and capital against it. The premise is that these mismatches are structural and legible, and that seeing them at once is different from reading them in sequence.

Financing Design (with the Finance Lab)
Design work in underserved communities has no natural financing structure: too small for institutional capital, too slow for philanthropy, too specific for grants. The program examines what instruments could exist—pooled community funds, cost-savings-backed structures, subscription and crowdfunding models—and what each would require to work.

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